Disrupted Attachment

Macomb Intermediate School District; An Information Booklet for Compliments of the Integrating Mental Health in Schools Federal Grant Macomb Intermediate School District Educators

Quick Facts:

Macomb Intermediate School District; Integrating Mental Health in Schools Federal Grant Disrupted

44001 Garfield Road Clinton Township, MI 48038 Attachment

Contact: Nancy Buyle Phone: 586.228.3439 Email: [email protected]

©2011 HowardCenter, Inc., Burlington, Vermont This publication was partially funded by the Office of Safe and Drug Free Schools (OSDFS) at the US Department of Education (ED). The content does not necessarily reflect the views of or imply endorsement by OSFDS nor ED. This fact booklet is intended to enhance understanding of school

personnel about the mental health issues that may be encountered HowardCenter, Inc. maintains full copyright of these materials. Only those parties purchasing materials directly from HowardCenter, Inc. may make adaptations spe- in students. The information included is not exhaustive and should cific to local information and resources. Changes to any other content may not be never be used to formulate a diagnosis. Mental health diagnoses made without the express written permission of HowardCenter, Inc. should be made only by a trained mental health professional after a thorough evaluation. These materials may be reproduced and distributed freely throughout Macomb County so long as there is no charge to users/recipients. Macomb Intermediate School District; Macomb Intermediate School District; Compliments of the Integrating Mental Health in Schools Federal Grant Compliments of the Integrating Mental Health in Schools Federal Grant

What is Disrupted Attachment? Getting Linked Healthy attachment is a reciprocal, enduring emotional connection Macomb County Community Mental Health between a child and his/her primary care-giver(s) that begins when http://macombcountymi.gov/communitymentalhealth/ the child is in utero. Resulting from care-giving that is attuned and Access Center: 586.948.0222 responsive to the child’s physical and emotional needs, secure attachment is an essential building block of cognitive, social, Macomb County Crisis Center http://www.macombcountymi.gov/volunteer/center.htm emotional, and physical development. Characteristics such as 24/7 Crisis Line: 586.307.9100 empathy, capacity to love, and inhibition of aggression are all related to a child’s sense of secure attachment in the world. CARE of Southeastern Michigan http://www.careofmacomb.com/ For some children, this attachment is disrupted through a variety of Main Office: 586.541.CARE (2273) circumstances such as the abrupt loss of or extended separation from a parent, child abuse or neglect, invasive and/or painful medical procedures, prenatal exposure to toxins and/or neurological Child/Adolescent Psychiatric Hospitals problems. A child is at highest risk of attachment related problems if Harbor Oaks Hospital Havenwyck Hospital these disruptions occur during the first two years of their life. 35031 23 Mile Road 1525 Universit y Drive New Baltimore, MI 48047 Auburn Hills, MI 48326 Problems of attachment fall along a spectrum ranging from children (586) 725 -5777 248-373-9200 (Main Line), 1 -800-401- at the mild end who can be described as having attachment related 2727 (Toll-Free), 248-377-8160 (TTY) issues (they can attach, but may have difficulty maintaining the Henry Ford Kingswood Hospital (must be medically cleared through 10300 West Eight Mile Road another hospital’s ER prior to attachment over time) to the wholly unattached child at the severe Ferndale, MI 48220 admission) end of the continuum. Phone: (248) 398-3200 must be medically cleared through another hos pital’s ER prior to admission)

Additional Resources Reactive Attachment Disorder Child Trauma Academy Nat’l. Alliance on Mental Illness When the symptoms of a poorly attached child lead to www.childtrauma.org www.nami.org profoundly disturbed and developmentally inappropriate social Association for Treatment and relatedness, the child may be given the diagnosis of Reactive Daniel Hughes www.danielhughes.org Training in the Attachment of Attachment Disorder (RAD). The subtypes of RAD are: Children Inhibited subtype: These children persistently fail to respond to or School Psychiatry Program www.attach.org/ initiate social interactions in a developmentally appropriate way. Massachusetts General Hospital www.schoolpsychiatry.org Disinhibited subtype: These children are indiscriminate in their choice of attachment figures. In other words, they may seek love and/or American Academ y of Child and attention from anyone. Adolescent Psychiatry www.aacap.org/ Many children experience attachment disruptions and related problems. RAD, however, is a serious diagnosis that is rarely given. Macomb Intermediate School District; Macomb Intermediate School District; Compliments of the Integrating Mental Health in Schools Federal Grant Compliments of the Integrating Mental Health in Schools Federal Grant

Prevalent Signs & Symptoms of Disrupted Attachment

Interpersonal Relationships - may include lack of trust in caregivers or adults in positions of authority; resistance to nurturance or guidance; difficulty giving and receiving genuine affection or love; superficial charm and lack of authenticity in interpersonal responses; inability to interpret facial expressions Cultural Considerations and body cues necessary for appropriate interpersonal interactions; poor social skills Cross-cultural studies have shown that the instinct for parent-child attachment is Emotional Functioning - may include limited capacity for universal, regardless of ethnic or cultural emotional self-reflection; minimal ability to recognize the differences. However, there are children who emotions of others; poor emotional regulation (moodiness, are at greater risk for the development of extreme fluctuations in emotions, “falling apart” when faced attachment related problems. These include with stress); low self-esteem children in families with other high risk factors Behavior - may include demanding, clingy, and/or overt or such as families with a history of child abuse covert over-controlling behavior; incessant chatter; temper and neglect, domestic violence, substance tantrums; minimal self control; regressed behavior; chronic abuse, and parental mental illness. lying; stealing; property destruction; acting out in order to Children who have experienced early harmful provoke anger in others; aggression; abnormal speech and care, especially those involved in the foster eating patterns; impulsivity care system who have received inconsistent care from multiple caregivers, are more likely Cognitive/Moral Development - may include lack of to be diagnosed with an attachment disorder, understanding of cause and effect; decreased capacity for self- as are children who have been adopted reflection and abstract thinking; limited compassion, empathy, following institutional deprivation, as and remorse; uneven learning profile (learns well sometimes sometimes happens with children in but not others); difficulty concentrating and attending to school international orphanages. related tasks

Macomb Intermediate School District; Macomb Intermediate School District; Compliments of the Integrating Mental Health in Schools Federal Grant Compliments of the Integrating Mental Health in Schools Federal Grant

Developmental Variations Though most of the symptoms below can occur across a child’s development, some may be more prominent or first emerge at different developmental Educational Implications stages: Children with disrupted attachment often lack Early Childhood investment in achieving academic success as their Delayed development of motor skills energy is focused on self-protection from what they Severe colic and/or feeding difficulties; failure to perceive to be an unpredictable and unsafe thrive environment. Often this focus on control and Resistance to being held, touched, cuddled, or protection results in disruptive or maladaptive comforted behavior and a difficulty displaying focused attention or concentration on school related tasks. The limited Lack of response to smiles or other attempts to ability for self reflection and understanding of cause interact and effect that may be experienced by children with Lack of comfort seeking when scared, hurt, or sick disrupted attachment can affect their follow through Excessive independence; failure to re-establish on common school tasks such as homework and can connection after separation impact their cooperation with peers. These students often lack responsiveness to the types of intrinsic motivation and reward that underlie many school School-age Children activities, such as academic achievement or the drive Frequent complaints about aches and pains to please school related adults. Age inappropriate demands for attention Disinvestment in school and/or homework Inability to reflect on feelings or motives regarding behaviors Inability to understand the impact of behavior on others, lack of response to consequences Inability to concentrate or sit still

Difficulty with reciprocity (give and take) in relationships May appear amoral (lacking moral development) Lying and stealing

Adolescence Aggressive, anti-social, impulsive, risk-taking, or delinquent behavior Substance abuse

Higher levels of disengagement Related depression and/or anxiety

Macomb Intermediate School District; Complimentsof the Integrating Mental Health in SchoolsFederal Grant

School and Classroom Strategies: Attachment

This Quick Fact Sheet contains strategies designed to address potential symptoms of disrupted attachment and should be used in consultation and collaboration with your school’s mental health personnel or as part of a larger intervention approach. These pages contain only a portion of many possible strategies available to address symptoms of disrupted attachment in the classroom. Strategies should always be individualized and implemented with careful consideration of the differences of each child and the context of their individual circumstances. Additionally, this information should never be used to formulate a diagnosis. Mental health diagnoses should be made only by a trained mental health professional after a thorough evaluation.

If you notice a significant change in mood or behavior in any child that lasts for more than a week, share your observations with the child’s parent and/or guardian and with your school’s mental health support team

General Information for Working with Students with Disrupted Attachments

 Children with attachment related issues may have had experiences that taught them that the world will not understand their needs nor keep them physically or emotionally safe. Many have learned, therefore, that they must assume absolute control if they are to survive. Relinquishing that control creates a debilitating level of anxiety for these students that has a dramatic impact on their ability to function at school, as it is not possible for them to simultaneously direct their efforts toward self–protection and toward learning. One key to working with students with attachment related issues is to provide the student with choice and a sense of control, though within the limits set by the adults in charge (freedom within limits).

 While many students with disrupted attachments interpret the world as unable to keep them safe, some unconsciously assume that the world’s inability to take care of them actually indicates that they are not worth being taken care of. These students may try to create experiences that “prove” these beliefs to be true. In some of these instances, students will try to recreate experiences of abuse and neglect or abandonment by others by eliciting reactions of anger, hate, or intolerance. If they are successful in facilitating adult anger, abusive behavior or abandonment, the student’s view of themselves as “un-loveable” will be affirmed. School and classroom efforts to reshape the child’s sense of trust in people must be guided by calmness, curiosity, and empathy as well as refusal to get pulled into the child’s unconscious efforts to have people reject them.

Strategies for Attachment Related Social Difficulties

 Model healthy social relationships  Help the student to recognize inappropriate social interactions (i.e. bring attention to inappropriate  Teach the student positive ways to interact with others (social skills) comments when they occur, stop an activity when inappropriate social interactions happen)  Provide opportunity for the student to work with peers who will model appropriate social skills  Address inappropriate social interactions privately with the student rather than in front of his/her  Interact often with the student to monitor his/her peers social interactions  Communicate your concerns regarding the  Reinforce the student for demonstrating positive, student’s social difficulties with the family, other appropriate social skills school staff, etc.

©2011 HowardCenter, Inc., Burlington, Vermont

This publication was partially funded by the Office of Safe and Drug Free Schools (OSDFS) at the US Department of Education (ED). The content does not necessarily reflect the views of or imply endorsement by OSFDS nor ED. HowardCenter, Inc. maintains full copyright of these materials. Only those parties purchasing materials directly from HowardCenter, Inc. may make adaptations specific to local information and resources. Changes to any other content may not be made without the express written permission of HowardCenter, Inc. These materials may be reproduced and distributed freely throughout Macomb County so long as there is no charge to users/recipients.

Macomb Intermediate School District; Complimentsof the Integrating Mental Health in SchoolsFederal Grant

Strategies for Attachment Related Behavior Problems

 Intervene early and intensively  Do not give second or third chances to a student who is misbehaving; instead explain “I see that you  Make time to spend talking and listening to the are not ready to do ” and then provide a student logical consequence  Be empathic and nurturing; be attuned to their  Use humor to deflect provocative behavior response to your nurturance and respond accordingly (i.e. if student becomes anxious in  When the student misbehaves, do not ask “did response to you putting your hand on their you…”, “why did you…”what did you…” shoulder, try a high five instead) questions  Learn as much as you can about attachment and  If a student misbehaves, try saying “I see you need attachment related problems; these children can be help with ”; this strategy helps to promote self- very challenging, and the more you understand reflective capacity them, the more effective and committed you may  If the student behaves in a way that elicits anger in be in your relationship with them you, label the behavior and tell the student how  Take the time to understand the motivation you feel about their behavior; show a mild degree underlying the student’ behavior; consult with of anger for 30 seconds (less if they cannot tolerate your school’s special education staff or behavioral 30 seconds), then change the tone of your voice to specialists about conducting a functional behavior one of assurance and acceptance; this will help the analysis if the underlying motivation is not child to develop a capacity for healthy shame, to apparent see emotions match with a proper affect, and to see that you are not going to hurt or leave them  Interact with these students based on their because of their behavior emotional age; some of these children and adolescents may be “stuck” in a younger age of  If student demonstrates poor physical boundaries emotional development and do not have the skills or indiscriminate sociability (i.e. hugging someone to “act their age” who enters the classroom) avoid lecturing them; rather provide a gentle suggestion for appropriate  Students with attachment related concerns are boundaries “why don’t you shake the principal’s often confused about what behaviors and hand when she joins us” emotions are appropriate; model healthy and appropriate behavior and emotions at all times  Have patience and understanding and remember that the student is acting from a place of fear and a  Be consistent, repetitive, and predictable true belief of worthlessness and un-loveability;  Provide the student with ample opportunities to each time they are successful in driving people make genuine choices in order to promote his/her away by their behavior, their worldview of need for control; allow freedom, but within limits themselves is only further entrenched set by the adults in charge  Be sure to seek personal support from others when  Provide concrete, specific and authentic praise; be dealing with attachment related behaviors; these aware that too much praise may be met with behaviors are likely to evoke a range of emotions skepticism and mistrust in school staff  Provide some rewards that are not contingent  Partner with parents/guardians and mental health upon the student accomplishing anything related professionals when working with students with attachment related behaviors; without strong  Respond consistently and calmly to unacceptable partnership, efforts by these children to behavior; approach the student with a “matter of “split” (pitting one adult against the other) may be fact” voice successful and intervention attempts sabotaged  Discipline students with natural/logical consequences; avoid consequences that perpetuate the student’s negative sense of self